How does this medication work? What will it do for me?

Lorazepam belongs to the class of medications called benzodiazepines. Lorazepam is used for the short-term relief of the symptoms of excessive anxiety. It works by slowing down the communication between the nerves in the brain (i.e., the central nervous system).

Some people experience some improvement in anxiety about half an hour after taking lorazepam. Injectable lorazepam can be used as an initial treatment for the control of prolonged seizures (status epilepticus).

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

How should I use this medication?

Anxiety: The recommended starting dose of lorazepam for adults is 2 mg per day. The dose is individualized according to your specific needs and response to the medication. This dose can be increased by your doctor to as high as 6 mg per day in 2 to 4 divided doses.

If you are taking the sublingual tablets, place the tablet under the tongue. The medication will dissolve in about 20 seconds. You should not swallow for at least 2 minutes to allow the medication to be absorbed into the body.

Seizures: The dose of injectable lorazepam for seizures is based on body weight and given by a trained health care provider in a hospital.

Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

It is important to take this medication exactly as prescribed by your doctor. If you have been taking this medication regularly, do not stop taking the medication without speaking with your doctor. A gradual reduction in dose is recommended when stopping this medication to avoid withdrawal effects.

If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.

Store lorazepam tablets at room temperature, protect from light and moisture, and keep them out of the reach of children. The lorazepm injection is stored in the fridge.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take lorazepam if you:

are allergic to lorazepam, other benzodiazepines, or any ingredients of the medication

have acute narrow-angle glaucoma

have myasthenia gravis

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

clumsiness or unsteadiness

dizziness or lightheadedness

drowsiness

slurred speech

Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

abnormal thinking (disorientation, delusions, or loss of sense of reality)

anxiety

behavioural changes (e.g., aggressiveness, angry outburst)

blurred vision or other changes in vision

changes in appetite

changes in sexual desire or ability

constipation

diarrhea

dry mouth

false sense of well-being

fast, irregular heartbeat

headache

increased watering of mouth

memory problems

muscle spasm

muscle weakness

nausea or vomiting

problems with urination

rash

trembling

unusual bleeding or bruising

unusual excitement, nervousness, or irritability

unusual tiredness or weakness

yellow eyes or skin

Stop taking the medication and seek immediate medical attention if any of the following occur:

breathing difficulties

chest pain

convulsions (seizures)

hallucinations

skin rash or itching

swelling of face, lips, tongue, or throat

vision changes or drooping eyelid

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

HEALTH CANADA ADVISORY

December 22, 2017

Health Canada has issued new restrictions concerning the use of Ativan® (lorazepam). To read the full Health Canada Advisory, visit Health Canada's web site at healthycanadians.gc.ca.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Allergic reaction: Some people may develop a serious allergic reaction to this medication. Signs of an allergic reaction include a severe rash, hives, swollen face or throat, or difficulty breathing. If these occur, seek immediate medical attention.

Dependence and withdrawal: Physical dependence (a need to take regular doses to prevent physical symptoms) has been associated with benzodiazepines such as lorazepam. Severe withdrawal symptoms may be experienced if the dose is significantly reduced or suddenly discontinued. Withdrawal symptoms can include:

abdominal cramps

agitation

confusion

diarrhea

extreme anxiety

headache

irritability

memory impairment

muscle pain

nervousness

restlessness

sleep problems

tension

tremors

vomiting

Reducing the dose gradually under medical supervision can help prevent or decrease these withdrawal symptoms. If you have a history of addiction or substance use problems, discuss the risks and benefits of the medication with your doctor.

Depression: People who have preexisting depression may experience emerging or worsening symptoms of depression while taking this medication. If you experience this, contact your doctor as soon as possible. People with depression should be treated with appropriate antidepressant therapy.

Drowsiness/reduced alertness: People taking lorazepam should not drive a car or perform hazardous tasks until they determine that this medication does not impair their ability to perform these tasks safely. Avoid drinking alcohol, as it can increase the drowsiness effects of this medication.

Lung disease: If you have underlying lung disease (e.g., chronic obstructive pulmonary disease, sleep apnea), discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Pregnancy: Taking lorazepam during the first trimester of pregnancy may result in an increased risk of certain birth defects. This medication should not be used during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking lorazepam, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and effectiveness of using this medication have not been established for those under 18 years of age.

Seniors: Seniors may be more likely to experience side effects of lorazepam, such as sedation (drowsiness) and impaired coordination. Seniors should discuss with their doctor the risks and benefits of taking this medication.

What other drugs could interact with this medication?

There may be an interaction between lorazepam and any of the following:

alcohol

aminophylline

anticonvulsants (e.g., carbamazepine, phenytoin, valproic acid)

antidepressants (e.g., fluoxetine, paroxetine, venlafaxine)

antihistamines (e.g., chlorpheniramine, diphenhydramine)

antipsychotics (e.g., olanzapine, risperidone)

barbiturates (e.g., phenobarbital, secobarbital)

cyclobenzaprine

clozapine

haloperidol

methadone

MAO inhibitors (e.g., phenelzine, tranylcypromine)

narcotics (e.g., codeine, morphine)

other benzodiazepines (e.g., clonazepam, temazepam)

probenecid

scopolamine

sedatives (e.g., zolpidem, zopiclone)

theophylline

tricyclic antidepressants (e.g., amitriptyline, nortriptyline)

valerian

valproate

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

stop taking one of the medications,

change one of the medications to another,

change how you are taking one or both of the medications, or

leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications; you should let your prescriber know if you use them.